| NPI | 1255755716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0075031) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101258686) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2025-07-15 |